The Scottish Cancer Referral Guidelines have been updated and went live on Wednesday, 6th August 2025.
We are working hard to update all relevant information on the RefHelp website. If you would like to see the guidelines please click here https://www.gov.scot/publications/scottish-referral-guidelines-suspected-cancer-2025/
For patients who have post-menopausal bleeding and are not on HRT, please see link to PMB No HRT page
Thrombocytosis is a risk marker for malignancy. This especially applies to the ‘LEGO-C’ group – Lung, Endometrial, Gastric, Oesophageal and Colorectal cancer. See Thrombocytosis – RefHelp for more information.
MM & RC 22/1/26
How to refer:
1.For patients with unscheduled bleeding on HRT:
Refer to Radiology for Unscheduled Bleeding on HRT USS Sci-Gateway > ELCH/LB/RIE/SJH > Clinical Radiology > LI Unscheduled Bleeding on HRT
If the USS report is reported as non-reassuring, the Primary Care Clinician to refer patient to Gynaecology
Sci-Gateway > RIE > Gynaecology > LI PMB Abnormal Ultrasound
There are 2 situations, as below, where patients who are, or have recently been, on HRT should be referred for a PMB USS (not an Unscheduled Bleeding on HRT USS):
- Ongoing unscheduled bleeding after a total of 12 months of HRT despite troubleshooting actions
- Ongoing bleeding at 6 weeks since stopping HRT
2.For patients with ongoing unscheduled bleeding after a total of 12 months of HRT despite troubleshooting actions:
USOC Referral Gynaecology Sci-gateway > RIE > Gynaecology > LI Basic sign referral (select priority USOC) and simultaneous referral to Radiology for PMB USS Sci-Gateway > ELCH/LB/RIE/SJH > Clinical Radiology > LI PMB (No HRT)
3.For patients with ongoing bleeding at 6 weeks since stopping HRT
USOC Referral Gynaecology Sci-gateway > RIE > Gynaecology > LI Basic sign referral (select priority USOC) and simultaneous referral to Radiology for PMB USS Sci-Gateway > ELCH/LB/RIE/SJH > Clinical Radiology > LI PMB (No HRT)
4.For suspected vulval, vaginal, cervical malignancy:
USOC Referral Gynaecology Sci-Gateway > RIE> Gynaecology> LI Basic sign referral (select priority USOC)
